Archived: Professional Care Services Bucks Ltd

Professional Care Services Bucks Ltd is registered to provide personal care and support to people in their own homes. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. At the time of the inspection the service supported 51 people.

People’s experience of using this service and what we found

People continued to be supported by an inadequate service. The registered manager and provider had failed to act on our previous concerns. The registered manager had employed a consultant to help drive improvement, however, the support provided was ineffective and did not have a positive impact or ensure the required improvements were made.

The service was not consistently well led. The registered manager was unable to demonstrate they were able to run a regulated service. We had major concerns about their conduct and treatment of people, their relatives and staff. We found the registered manager had described people as “Idiots” and routinely described people as their medical condition. For instance, they often referred to people as “Mental Health”. In meetings with the local authorities the registered manager described staff as “awkward”.

People and their relatives told us, “[The owner] took things a bit too personally and “She’s just a bad manager”.

People and their relatives told us the service was very poorly run. They described the service as “shambolic”. Other comments included, “They’re ill mannered, [the people in office], some of them. You can never get anybody high up [in the office]. I can never get in touch with anybody to speak to [about my concerns]” and “They have bad management.”

People were placed at risk of harm and abuse. The registered manager and provider failed to ensure risk assessments were completed. The management team and staff lacked understanding about safeguarding thresholds and failed to report events to the local authority.

People were placed at risk due to poor recruitment and training of staff. The registered manager and provider failed to ensure all the required pre-employment checks were completed. Staff were supporting people without the minimum training. One staff had been in post since 25 May 2021 and they had only completed three on-line training courses. They had been supporting people with prescribed medicine without any training or competency training.

The registered manager and provider did not have effective systems in place to manage complaints. At the inspection the registered manager asked office staff “Who deals with complaints”.

People did not have care plans which reflected their preferences. People were not routinely treated with dignity and respect.

The registered manager and provider failed to ensure they were open and transparent when care was not delivered as planned. The registered manager failed to make all the required statutory notifications to the Care Quality Commission, when required.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; as the policies and systems in the service did not support this practice. We found the service failed to act in accordance with the Mental Capacity Act 2005.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (published 12 April 2021) and there were 12 breaches of the regulations. We issued urgent enforcement action to prevent the provider from taking on additional people. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of multiple regulations.

This service has been in Special Measures since the last inspection and remains in special measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. Since the last inspection we have continued to receive concerns about the management of the service. We received no reassurance from the provider the required improvements were being made.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Professional Care Services Bucks Ltd on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified multiple breaches of regulation. These were in relation to the management of the service, the management of risk, safeguarding people from abuse, record keeping related to care provided, complaints, medicines, staff recruitment and ongoing support and monitoring of staff performance and training. The provider had failed to notify CQC of certain events, to comply with the Mental Capacity Act 2005 and to monitor and improve the quality of the service to people.

Follow up

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. We identified ongoing breaches of the regulations and we considered escalating our enforcement powers. This could have lead to cancellation of their registration or to varying the conditions of their registration.

We worked closely with the provider and were honest about the level of concern we had about people's safety. The provider informed us they wished to cancel their registration with us. They have now applied to cancel their registration and will no longer be providing support to people.

Professional Care Services Bucks Ltd is registered to provide personal care and support to people in their own homes. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. At the time of the inspection the service supported 93 people.

People’s experience of using this service and what we found

People were not routinely provided with person-centred care. People told us care was regularly unplanned and they were left uncertain as to who was going to attend. A person commented, “We were supposed to have one girl for most of the mornings, but we are getting loads of different people, never know who is coming and then you have to explain it all over again.”

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; as the policies and systems in the service did not support this practice. We found the service failed to act in accordance with the Mental Capacity Act 2005.

The provider did not enable people to be involved in making decisions about care and people were not routinely supported as they wished. The general feedback received from people and those who represented them about the lack of timely calls, continuity of care, and negative impact of the registered manager’s behaviour towards them meant people were not treated with dignity and respect all times.

People were not routinely and effectively protected from potential avoidable harm. The provider had not ensured they had done all that was reasonably practicable to mitigate risks. The registered manager and nominated individual were unable to demonstrate a good understanding of risk management. We found people were placed at potential risk of harm due to the poor management of risks.

Systems were either not in place or robust enough to ensure the proper and safe management of medicines and the provider failed to follow government guidance in relation to wearing personal protective equipment (PPE) in the office to prevent and control the spread of infection in relation to COVID-19.

People were not always adequately protected from abuse or the risk of improper treatment as systems and processes were not operated effectively at the service. The registered manager did not ensure staff took appropriate action when an accident or incident happened.

The provider failed to protect people from risks posed by staff. Recruitment systems and processes in place were unsafe. Pre-employment checks were not robust and did not fully assess the candidate’s suitability for the role. Disciplinary records showed two staff had committed acts of gross misconduct following their appointment and were dismissed. The recruitment records for both members of staff showed that issues of concern were not followed up during the recruitment process which could have prevented this.

The provider did not make sure there were sufficient suitably qualified, competent, skilled and experienced staff and staff were not appropriately supported to ensure peoples’ care needs could be met. Assessments of people’s needs were ineffective as they failed to include all of peoples’ needs and expected outcomes for supporting people with meals, were not always met.

People’s preferences for care and support were not fully reflected in care plans, this included wishes and preferences for end of life care. Reviews of care did not ensure the care and support delivered still met people's needs. This meant people could not always be confident the service would be responsive to all their care and support needs.

The registered manager demonstrated a lack of understanding about how to manage concerns raised. We found the provider did not operate an accessible system for identifying, receiving, handling, and responding to complaints.

People and staff told us about their concerns about the culture of the organisation but felt unable to share these with the provider for fear of repercussions. There was a lack of confidence in the registered manager’s ability to run the service. Comments included, “Quite frankly the owner of the company is not fit to be a business owner. She takes it all personally and does not take the patients’ perspective” and [name of registered manager] is really intimidating.”

The service did not actively encourage feedback about the quality of care and support delivered. Quality assurance systems were ineffective and had not identified the concerns we had found during our visits. Where information was gathered, they failed to analyse the data to establish if there were any patterns or trends and, use any findings to drive improvements.

We found multiple breaches of Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

This service was registered with us on 2 May 2019 and this is the first inspection.

Why we inspected

This was a planned comprehensive inspection to assess compliance with the regulations since the service was registered. The inspection was prompted in part due to concerns received about the management of the service. Several concerns had been raised with us about the conduct of the registered manager, staff training, lack of support and supervision for staff and poor planning of care visits.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified multiple breaches of regulation. These were in relation to the management of the service, the management of risk, safeguarding people from abuse, record keeping related to care provided, complaints, medicines, staff recruitment and ongoing support and monitoring of staff performance and training. The provider had failed to notify CQC of certain events, to comply with the Mental Capacity Act 2005 and to monitor and improve the quality of the service to people.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.